00:01
Hi! My name is Jill Beavers-Kirby. And today
we’re going to be talking about intravenousand parenteral therapies. So, why do we need
to give IV therapy? First of all, let me justpoint out that starting an IV is not a test
that you can delegate to somebody who’sunlicensed. This is true in all 50 states.
So, the registered nurse will have to startthe IV. So, why do we need an IV? Well, sometimes
we need it for fluid replacement, or sometimeswe need it for electrolyte replacement such as
potassium. The purpose of the IV will determinethe type of the IV that’s inserted, the
size also known as the gauge, and what typeof tubing you’ll need. So, what kind of
personal protective equipmentdo we need when we start an IV? Gloves are
always worn when you start an IV or when youstick somebody with a needle. And gloves are
always worn when you’re stopping the IVor discontinuing. The gloves are clean gloves.
They don’t have to be sterile gloves fora peripheral IV. So, basic nursing facts,
you’re going to want to remember to lookat the IV site every two hours. Is there any
edema or swelling or redness or tendernessaround the IV site? Is there any drainage
around the IV site? Is there any bleedingat the IV site? These are all abnormal signs
that you’ll want to stop the IV for anddo something about. As I said before, you want
to wear clean gloves,not sterile, when stopping your IV. After you
stopped the IV and you pulled the catheterout, you’ll want to hold manual pressure
for about one to three minutes to make surethe bleeding has stopped. So, what are some
complications of IV therapy? One is occlusion.
01:45
This simply means that something is occluding,
the tubing, or the infusion from going in.
01:51
This can be like a crimped tubing or something
a patient even bending their arm if the IVsite is in their elbow. Another complication
can be an infiltration. This is when IV fluidswill seep into the subcutaneous tissue around
the IV site. Depending on the fluid, you mightsee the skin turn like a whitish color which
is called pallor, or it might be cool becauseof the temperature of the IV fluid. Another
complication is phlebitis, and probablya lot of people have heard of this. This is
irritation and inflammation along the veinof the actual arm or body part that the IV
is in. You’ll see erythema, redness, andit can be a little tender. And then, the last
complication is skin damage. This is usuallyseen with toxic medication such as chemotherapies.
The skin may be really white or it may bereally red and you can get blisters around
the site. And it is usually almost alwayspainful. Another IV fluid that we infuse
frequentlyis called total parenteral nutrition or TPN.
So, what is the purpose of TPN? This is usedto give patients nutrients who can’t keep
up with their own nutritional needs. You’llsee this in patients who have chronic nausea
and vomiting, patients with stomach cancers.
03:17
There is a lot of reasons why a patient might
need TPN. But TPN has to be infused througha large catheter that goes centrally into
the system. You can’t infuse TPN througha small little peripheral IV in somebody’s
hand or somebody’s arm because there isa lot of sugar in this medication, and it
can cause damage to your skin. So, it willcontain glucose, other nutrients. It can even
contain lipids which are body fats, and itwill make the TPN look sort of like a
milky color.
03:50
So, why do we use TPN? This is needed for
nutrition and to provide somebody electrolyteswhen they can’t keep up with their own nutritional
needs. What type of personal protective equipmentdo we need? As stated before, TPN goes centrally
into somebody’s system, so you have to wearsterile gloves and use sterile technique any
time you work with TPN. So, the flow rateof the TPN is usually determined by the pharmacist.
It can’t be given too fast because the patientcan’t get an overload of glucose, especially,
or other electrolytes like potassium.
04:27
And it can’t be given too slow because this
will cause the IV line to clog off from thisheavy sugary solution. So, the goal is to
usually give one to twoliters over 24 hours. And as stated before,
your pharmacist will figure out the flow rate.
04:42
So, how do we care for the patient who is
receiving TPN? Our biggest concern is to preventinfection with these patients. We want to
maintain sterility. I cannot express thatenough. Remember sterile technique and sterile
gloves. Once again, you have to assess yourIV site every two hours. Remember, we’re looking
for erythema, redness, leakage, phlebitis,pain at the site. Anything that looks abnormal,
you need to let the physician know right away.
05:14
We also do sterile dressing changes on TPN
and central line IV sites. So your hospitalor your institution that you’re working at will
have their own policy about how frequentlyto change these central line dressing sites.
The standard is usually every 48 to 72 hours,about every two to three days. Obviously,
if the site gets soiled or if there’s leakageor bleeding or anything, you’ll change the
site sooner. Just remember, you have one IVline for your TPN. Nothing else can be infused
with this. You can’t piggyback any otherIVs into this. You cannot give blood through
the same line that you’re giving TPN.
05:55
And you can’t give any medications in the same
line that you’re giving a TPN.
05:59
That’s because there are so many nutrients and other
electrolytes in the solution that it justdoesn’t mix with other medications or blood.
Never ever, ever, ever can you do this, never.
06:10
If you need to give a medication or blood,
you’re going to have to get another IV accesspoint. So, how do we maintain the TPN system?
First thing is we prevent complications.
06:22
The nurse will often assist the physician in putting
in these lines. These lines can be put inat the bedside or in an official OR suite.
So, one of the potential complications iscorrect placement. These lines are often placed
in large veins, such as the subclavian veinor the internal jugular vein. So, correct placement
has to be verified by a chest X-ray.
06:46
Just because you get blood return from the line
does not mean that the line is in the correctplace. Please remember that. You have to have
a chest X-ray verifying the placement beforeyou put anything into this line. Always,
always, always.
07:00
Another potential complication is an air embolus.
Air emboli can occur during insertion becauseonce again, we’re going into the large veins
or it can occur after insertion if you don’thave the connections on your IV tubing tightened
down. A patient can get an air embolus.
07:19
So, what is another complication of TPN? Hyperglycemia
which is when the patient’s blood glucoselevel is greater than 150. This can be caused
from the amount of dextrose solution in theactual TPN, or from running the solution too
fast, or from infection. Infection in a person’sbody feeds off a glucose so your body will
make more glucose thinking that the glucoselevel is low if you have an active infection.
Or some medications that the patient is takingcan also lead to elevated blood glucose levels
when you’re giving a sugary solution inthe veins. Some of these medications are blood
pressure pills. And as we know, a lot of our patientsare going to be on blood pressure pills. So,
for the hyperglycemia, it’s usually a standingorder to monitor somebody’s blood glucose
every six hours or four times a day.
08:12
You’ll have to get your institution’s policy to
see which one you need to do.
08:16
On the reverse side, another potential complication
is hypoglycemia. This is when your blood glucoselevel falls below 70. This is usually caused
from too much insulin in the TPN solutionbecause you have to have insulin in the TPN
solution because you have glucose in theTPN solution, so they have to balance each
other out. Another way that hypoglycemia iscaused is if you just suddenly go in and stop
the TPN. So say, for example, the physiciansays, “Okay. We can stop this patient’s
TPN. Here, she’s eating well and we’llbe able to get rid of this.” Well, you don’t
just go and stop it. You usually will cutthe rate in half. So for example, if somebody
is getting 84 ml of TPN an hour, you’llcut the rate in half to 42 ml an hour for
the next two hours, and then you can turnthe solution off. You have to taper down the
solution. You can’t just stop it becausethe patient’s blood sugar will crash. It’s
not a very fun picture.
09:17
So, what is the nursing assessment for IVs
and TPN? Well, we look at the site how often?Every two hours. You want to make sure that
there’s no redness, no drainage, no edema,no tenderness, no erythema. The IV site should
look just as good as it did the day the IVwas put in. Peripheral sites, they can stand
for about 72 to 96 hours. That’s three tofour days. Most institutions will say 72 hours.
On a rare occasion, they’ll say, “Okay.
09:51
This person has a hard stick. We’ll go ahead
and leave it in for another day as long asthe site looks okay.” That is rare and you
need to make sure that you’re reading yourinstitution’s policy so you understand what
your institution wants you to do. My nameis Jill Beavers-Kirby, and this has been your lecture
on intravenous and parenteral therapy. Thank you.

About the Lecture

The lecture Parenteral/Intravenous Therapies by Jill Beavers-Kirby is from the course Physiological Integrity. It contains the following chapters:

Intravenous and Parenteral Therapy

Total Parenteral Nutrition (TPN)

Maintenance of the TPN System

Nursing Assessment

Included Quiz Questions

Why do we start intravenous access?

To give fluids intravenously.

To practice our skills.

Because the nursing staff is bored.

Can starting intravenous access be a delegated task to a licensed practical nurse?

No

Yes

Author of lecture Parenteral/Intravenous Therapies

Jill Beavers-Kirby

Customer reviews

(1)
5,0 of 5 stars

5 Stars

5

4 Stars

0

3 Stars

0

2 Stars

0

1 Star

0

User Reviews

(1)
5,0 of 5 stars

5 Stars

5

4 Stars

0

3 Stars

0

2 Stars

0

1 Star

0

Subscribe to bookmark your content

Bookmarks will help you organize our more than 2000 medical videos,
and customize your learning experience for more efficiency and better results.

USMLE™ is a joint program of the Federation of State Medical Boards
(FSMB®) and National Board of Medical Examiners (NBME®). MCAT is a registered
trademark of the Association of American Medical Colleges (AAMC).
None of the trademark holders are endorsed by nor affiliated with Lecturio.